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Diseases of the Musculoskeletal System and Connec6ve Tissue

M00 – M50 (Part 2)

Presented by Lawrence San1, DPM, FASPS

Webinar 4b: Thursday, March 6, 2014

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APMA Educa1onal Informa1on: ICD-‐10 Webinars •  Register for upcoming webinars •  View archived recordings •  Download PDF versions of each presenta1on •  apma.org/icd10 or apma.org/webinars

Coding Resource Center •  apmacodingrc.org

Ques1ons •  Contact the Health Policy and Prac1ce Department •  [email protected] or 301-‐581-‐9200

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ICD-‐10-‐CM Resources www.apma.org/icd10

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APMA Coding Resource Center www.apmacodingrc.org

•  ICD-‐9 to ICD-‐10 crosswalks are now available.

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REVIEW OF SOME OF THE ESSENTIAL GUIDELINES AND INSTRUCTIONS FOR

CHAPTER 13 (M00 – M50)

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Specific Coding Guidelines for Chapter 13 (M00 – M99)

Site and laterality •  Most of the codes within Chapter 13 have site and laterality designa1ons. The site represents the bone, joint or the muscle involved. • Where more than one bone, joint or muscle is usually involved, such as osteoarthri1s, there is a “mul1ple sites” code available. •  For categories where no mul1ple site code is provided and more than one bone, joint or muscle is involved, mul1ple codes should be used to indicate the different sites involved.

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Bone versus joint

•  For certain condi1ons, the bone may be affected at the upper or lower end, (e.g., avascular necrosis of bone, M87, Osteoporosis, M80, M81). Though the por1on of the bone affected may be at the joint, the site designa1on will be the bone, not the joint.


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•  Chronic or recurrent condi1ons should generally be coded with a code from chapter 13.

•  If it is difficult to determine from the documenta1on in the record which code is best to describe a condi1on, query the provider.


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Coding of Pathologic Fractures

•  7th character A is for use on a pa1ent that is receiving ini1al treatment for the fracture.

•  7th character, D is to be used for encounters aeer the ini1al treatment for the fracture.

•  The other 7th characters, listed under each subcategory in the Tabular List, are to be used for subsequent encounters for treatment of problems associated with the healing, such as malunions, nonunions, and sequelae.


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Coding of Pathologic Fractures

•  Care for complica1ons of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complica1on codes.


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Osteoporosis

•  Osteoporosis is a systemic condi1on, meaning that all bones of the musculoskeletal system are affected.

•  Site is not a component of the codes under category M81, Osteoporosis without current pathological fracture.

•  The site codes under category M80, Osteoporosis with current pathological fracture, iden1fy the site of the fracture, not the osteoporosis.

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(M00-‐M50)

•  Use an external cause code following the code for the musculoskeletal condi1on, if applicable, to iden1fy the cause of the musculoskeletal condi1on.

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REVIEW OF EXCLUDES NOTES

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EXCLUDES NOTES •  Excludes1 note

– Indicates that code iden1fied in the note and code where the note appears cannot be reported together because the 2 condi1ons cannot occur together.

Example: E10 Type 1 Diabetes mellitus

Excludes1: diabetes mellitus due to underlying condi1on (E08.-‐) drug or chemical induced diabetes mellitus (E09.-‐) gesta1onal diabetes (O24.4-‐) hyperglycemia NOS (R73.9) neonatal diabetes mellitus (P70.2) type 2 diabetes mellitus (E11.-‐)

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•  Excludes2 note

– Indicates that condi1on iden1fied in the note is not part of the condi1on represented by the code where the note appears, so both codes may be reported together if the pa1ent has both condi1ons.

Example: L89 Pressure ulcer

Excludes2: diabe1c ulcers (E08.621, E08.622, E09.621, E09.622, E10.621, E10.622, E11.621, E11.622, E13.621, E13.622) non-‐pressure chronic ulcer of skin (L97.-‐) skin infec1ons (L00-‐L08) varicose ulcer (I83.0, I83.2)

EXCLUDES NOTES

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Painful Hallux Valgus – Lee Foot

In this presenta1on, we will learn to code using the new ICD – 10 classifica1on a pa1ent who presents with: 1. Hallux valgus of the lee foot 2. Osteoarthri1s of the lee foot and ankle 3. Pain in the lee limb

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Painful Hallux Valgus – Lee Foot (Ini1al Visit)

Consulta1on: Referring physician: Dr. XXXXXXX Chief Complaint: Mr. Jones, a 56 year old male, presents for an ini1al visit with a painful bunion on his lee foot.

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History of present illness: He states that the lee bunion has been hur1ng him for about 3 months. He has discomfort when he ambulates with shoes or sneakers. Taking his shoes off helps to make it feel beker. He does not remember any trauma and this is not work related.

Loca1on of injury: N/A


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Lee foot -‐ Foot type – pes planus Normal ROM -‐ subtalar, midtarsal, and ankle joints Forefoot reveals a moderate to severe hallux valgus deformity with par1al ROM Tenderness noted on both dorsiflexion and

plantarflexion of hallux Tenderness on palpa1on of medial eminence of bunion No signs of infec1on Muscle power/tone – WNL


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Radiological:

Review of pa1ent’s radiographs reveal a hallux valgus deformity with degenera1ve changes on the lee foot. Osteophytes noted on the head of the first metatarsal with subchondral bone cysts.


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Assessment: 1.  Hallux valgus, lee foot 2.  Osteoarthri1s lee foot and ankle 3.  Pain in lee hallux

Plan:

1.  Rx: Celebrex 200 mg. daily 2.  Discussed with pa1ent beker shoe gear with custom-‐

made ortho1cs 3.  Surgical op1ons were discussed 4.  Pa1ent to return for follow-‐up in one week


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Coding This Encounter Using ICD -‐ 9

Hallux Valgus – 735.0 Osteoarthri1s of foot and ankle – 715.17 Pain in joint – 719.47

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Code for Hallux Valgus: Go to Chapter 13 -‐ Diseases of the Musculoskeletal System and Connec1ve Tissue (M00-‐M99). M20 -‐ Acquired deformi1es of fingers and toes. M20.1 -‐ Hallux valgus (acquired). M20.10 -‐ Hallux valgus (acquired), unspecified foot. M20.12 Hallux valgus (acquired), lee foot.

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Code for osteoarthri1s lee foot: M19.0 -‐ Primary osteoarthri1s of other joints. M19.07 -‐ Primary osteoarthri1s ankle and foot. M19.072 Primary osteoarthri1s, lee ankle and foot.


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Code for pain in lee hallux: M25 -‐ Other joint disorder M25.5-‐ Pain in joint M25.50 -‐ Pain in unspecified joint M25.57 -‐ Pain in ankle and joints of foot M25.572 Pain in lee ankle and joints of foot


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Comparing ICD-‐9 and ICD-‐10 ICD-‐9 ICD-‐10

735.0 -‐ Hallux Valgus M20.12 -‐ Hallux valgus (acquired), lee foot

715.17 -‐ Osteoarthri1s of foot and ankle

M19.072 -‐ Primary osteoarthri1s, lee ankle and foot

719.47 -‐ Pain in joint M25.572 -‐ Pain in lee ankle and joints of foot

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The codes for this ini1al encounter of a pa1ent with a painful Hallux Valgus of the lee foot would be: ICD – 10: M20.12 Hallux valgus (acquired), lee foot. M19.072 Primary osteoarthri1s, lee ankle

and foot. M25.572 Pain in lee ankle and joints of foot

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Painful Ankle Right Ankle

In this presenta1on, we will learn to code using the new ICD – 10 classifica1on a pa1ent who presents with: 1.  Oteoarthrosis, localized, secondary to previous

trauma, right ankle 2.  Loose body in right ankle 3.  Chronic right ankle sprain 4.  Pain in right limb

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Painful Right Ankle (Ini1al Visit)

Consulta1on: Referring physician: Dr. XXXXXXX Chief Complaint: Mr. Smith, a 30 year old male presents for an ini1al visit with pain in his right ankle.

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History of present illness: He states that his right ankle has been annoying him for about 3 years, but now the discomfort is causing him to limp. The pa1ent recalls spraining his right ankle about 3 years ago while playing basketball. He was treated in the emergency room with a soe cast and was told that he had a bad sprain. He wore the soe cast for 2 weeks. He occasionally takes Motrin, 400mg, to help manage the discomfort.

Loca1on of injury: Playground, 3 years ago

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Right foot and ankle – Normal ROM of the subtalar and midtarsal joints. Limited and painful ROM of the ankle joint, especially dorsiflexion. Ankle joint appears stable. Pain on dorsiflexion and plantarflexion of the ankle. Tenderness on palpa1on of the anterior aspect of the ankle. Pa1ent ambulates with a slight limp. No edema noted. No signs of infec1on. Muscle power/tone -‐ wnl

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Radiological:

Review of pa1ent’s radiographs reveal a loose body located on the lateral aspect of the right ankle, dorsal to the talus. Osteophytes noted on the lateral aspect of the talus. There are no other fractures or disloca1ons.

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Assessment: 1. Oteoarthrosis, localized, secondary to previous trauma 2. Loose body in ankle 3. Chronic ankle sprain 4. Pain in limb

Plan: 1.  Rx: Celebrex 200 mg. daily 2.  Dispensed CAM walker, to be worn daily. 3.  Surgical op1ons were discussed. 4.  Pa1ent to return for follow-‐up in one week

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Oteoarthrosis, localized, secondary, ankle -‐ 715.27 Loose body in ankle -‐ 718.17 Chronic ankle sprain -‐ 845.00 Pain in limb -‐ 729.5


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Code for osteoarthrosis, localized, secondary, right ankle: Go to chapter 13 -‐ Diseases of the musculoskeletal system and connec1ve 1ssue (M00-‐M99). M19.1 -‐ Post-‐trauma1c osteoarthri1s of other joints M19.17 -‐ Post-‐trauma1c osteoarthri1s, ankle M19.171 Post-‐trauma1c osteoarthri1s, right ankle


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Code for loose body in right ankle joint: M24.0 -‐ Loose body in joint M24.07 -‐ Loose body in ankle and toe joints M24.071 Loose body in right ankle

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Code for chronic ankle sprain: S93.4 -‐ Sprain of ankle S93.40 -‐ Sprain of unspecified ligament S93.401 -‐ Sprain of unspecified ligament, right ankle S93.401S Sprain of unspecified ligament, right ankle

with sequela

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Code for pain in right ankle: M25 -‐ Other joint disorder M25.5 -‐ Pain in joint M25.50 -‐ Pain in unspecified joint M25.57 -‐ Pain in ankle and joints of foot M25.571 Pain in right ankle

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Comparing ICD-‐9 and ICD-‐10

ICD-‐9 ICD-‐10

715.27 -‐ Oteoarthrosis, localized, secondary, ankle and foot

M19.171 -‐ Post-‐trauma1c osteoarthri1s, right ankle

718.17 – Loose body in joint of ankle and foot

M24.071 – Loose body in right ankle

845.0 – Ankle sprain S93.401S – Sprain of unspecified ligament, right ankle with sequela

729.5 – Pain in limb M25.571 – Pain in right ankle

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The codes for this ini1al encounter of a pa1ent with a painful right ankle would be: ICD – 10:

M19.171 – Post-‐trauma1c osteoarthri1s, right ankle

M24.071 – Loose body in right ankle S93.401S – Sprain of unspecified ligament, right ankle M25.571 – Pain in right ankle

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Painful Tailor’s Bunion, Lee Foot (Ini1al Visit)

In this presenta1on, we will learn to code using the new ICD – 10 classifica1on a pa1ent who presents with: 1. Tailor’s Bunion, lee foot 2. Overlapping 5th digit, lee foot 3. Shorten limb, lee foot 4. Pain in lee foot

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Consulta1on: Referring physician: Dr. XXXXXXX Chief Complaint: Mrs. Jones, a 45 year old female, presents for an ini1al visit with a painful bump and an overlapping 5th toe on the lee foot.

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History of present illness: She states that the bump on the outside of her lee foot has been there for years but now she has pain when she ambulates with shoes. Over the past couple of years, she has also no1ced that her 5th toe on the same foot is now overlapping the 4th toe. She has difficulty ambula1ng with both shoes or sneakers. She has tried padding the area, but has not goken any relief.

Loca1on of injury: N/A

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Surgical History: The pa1ent relates a history of fracturing her lee 1bia right above her lee ankle 15 years ago and had surgical repair with a plate. The surgery healed unevenpully but she finds she walks beker with a heal lie placed in her lee shoe.

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Lee foot and ankle – Normal ROM-‐ subtalar, midtarsal, and ankle joints Forefoot reveals a moderate to severe tailor’s bunion with an overlapping 5th toe. There is tenderness on palpa1on of lateral eminence of the 5th metatarsal head. The pa1ent ambulates with a slight limp. On measuring both limbs, the lee leg measures ¼ inch shorter than the right. No edema noted. No signs of infec1on. Muscle power/tone -‐ WNL

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Radiological: Review of pa1ent’s radiographs reveal a hypertrohied lateral eminence on the 5th metatarsal head of the lee foot. The lee 5th digit appears deviated and overlapping the 4th toe. There are no signs of degenera1ve changes. There are no fractures or disloca1ons.

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Assessment: 1. Tailor’s Bunion, lee foot 2. Overlapping 5th digit, lee foot 3. Shorten limb, lee foot 4. Pain in lee foot

Plan:

1. Discussed proper shoe gear with pa1ent. 2. Discussed custom-‐made ortho1cs with pa1ent. 3. Discussed surgical op1ons with pa1ent. 4. Placed ¼ heel lie in lee shoe. 5. Pa1ent to return in one week for follow-‐up.

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1.  Tailor’s Bunion, lee foot – 727.1

2.  Overlapping 5th digit, lee foot – 735.8

3.  Shorten limb, lee foot – 736.81

4.  Pain in lee foot – 729.5

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Code for Tailor’s bunion, le] foot: Go to chapter 13 -‐ Diseases of the musculoskeletal system and connec1ve 1ssue (M00-‐M99). M21.-‐ Other acquired deformi1es of limb M21.6X-‐ Other acquired deformi1es of foot M21.6X2 Other acquired deformi1es of lee foot

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Code for overlapping 5th digit, le] foot: M20-‐ Acquired deformi1es of fingers and toes M20.5-‐ Other deformi1es of toe(s) (acquired) M20.5X-‐ Other deformi1es of toe(s) (acquired) M20.5X2 Other deformi1es of toe(s) (acquired),

lee foot.

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Code for shorten limb, le] foot: M21-‐ Other acquired deformi1es of limb M21.7-‐ Unequal limb length (acquired) M27.76-‐ Unequal limb length (acquired), 1bia

and fibula M21.762 Unequal limb length (acquired), lee 1bia

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Code for pain in the le] foot: M79.6-‐ Pain in limb, hand, foot, fingers and toes M79.60-‐ Pain in limb, unspecified M79.67-‐ Pain in foot and toes M79.672 Pain in lee foot

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Comparing ICD-‐9 and ICD-‐10 ICD-‐9 ICD-‐10

727.1 – Tailor’s bunion M21.6X2 – Other acquired deformi1es of lee foot

735.8 – Overlapping 5th digit M20.5X2 – Other deformi1es of toe(s) (acquired), lee foot

736.81 – Shorten limb M21.762 – Unequal limb length (acquired), lee 1bia

729.5 – Pain in limb M79.672 – Pain in lee foot

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The codes for this ini1al encounter of a pa1ent with a painful tailor’s bunion of the lee foot would be:

ICD – 10: M21.6X2 – Other acquired deformi1es of lee foot M20.5X2 – Other deformi1es of toe(s) (acquired), lee foot M21.762 – Unequal limb length (acquired), lee 1bia M79.672 – Pain in lee foot

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Next Webinar

Thursday, March 20, 2014 at 8:00 PM ET

Presented by David Freedman, DPM

Register at www.apma.org/webinars or www.apma.org/icd10


M51 – M99 (Part 1)

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Ques6ons?

diseasesofthemusculoskeletal ... is here...7 & bone&versusjoint& " •...

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